Prevalence, Indications and Morbidity of Caesarean Sections in a Referral Hospital of the Health Voucher Program: The Case of Garoua Regional Hospital in the Northern Region of Cameroon

Caesarean section (CS) is a surgical procedure performed to remove a fetus from the mother’s uterus through an incision on the abdominal wall, then on the uterine wall. The indications of CS vary not only between countries, but also from one hospital to another and from one team to another within the same hospital. Despite advances in asepsis and anesthesia/resuscitation technics, there are still complications of varying severity inherent to the gravid-puerperal state on one hand and the technics used on the other, irrespective of the operative indication. Thus, the present study was carried out with the objectives of determining the prevalence, identifying the indications, and evaluating the morbidity linked to caesarean sections in our environment. Cameroon has also set up a health voucher program in its northern region, aimed at reducing maternal and fetus morbidity and mortality. The program aims to improve financial access in antenatal care and deliveries, including caesarean sections, in this low-income region of the country. We conducted a descriptive cross-sectional study with retrospective data collection, from February 1, 2022, to May 31, 2022. We included all women who gave birth by caesarean section. In our study series, out of 905 parturient admissions into the Department of Obstetrics and Gynecology, 226 were caesarian cases. The overall frequency of CS during our study period was 25%. Fetal indications were dominated by cephalopelvic disproportion and non-reassuring fetal heart in 17.3% and 13.7% of cases respectively. Intraoperative complications were dominated by hemorrhage (15.5%). In our study, we noted an 11.1% of prevalence perinatal mortality. Cameroon is a low-income country with limited financial resources, especially in the Northern region. The health voucher program has improved financial access to caesarean sections for parturient in northern Cameroon, and consequently to emergency obstetric and neonatal care.

Prevalence and Factors Associated with HIV Serodiscordance among Infected Couples in the City of Parakou (Benin)

Introduction: Achieving the goal of “zero new human immunodeficiency virus (HIV) infections by 2030” requires the elimination of HIV transmission within serodiscordant couples. In Benin, the phenomenon of HIV serodiscordance remains poorly documented. Objective: the aim of this study was to determine the prevalence of HIV serodiscordance and its associated factors among infected couples in the city of Parakou. Study Framework and Method: This was a descriptive cross-sectional study with an analytical focusing on qualitative and quantitative plans. It was carried out on thirty approved sites in the city of Parakou between July and December 2022. We used a non-exhaustive convenience sample of people living with HIV (PLHIV) whose partner’s status was known. Data collection took place in two phases: an interview phase during which sociodemographic, economic, behavioral and marital/social data were collected. The second phase focused on clinical and therapeutic data which were collected from the patients’ personal records. Results: A total of 417 study subjects were recruited. The average age (SD) of the subjects was 38.17 (±10.25) years [37.19 - 39.16]. Females accounted for the largest proportion (79.62%). Most respondents (74.11%) were married. Monogamous unions were the most frequent, involving 67.87% of participants, most of whom (44.60%) had been infected for between 1 and 5 years. Couples in union for less than 10 years were the most numerous (218 people or 52.28%). The respondent was head of household among only 140 respondents (33.57%) of which 84 men (60.00%) and 56 women (40.00%). Female heads of household were mainly divorcees and widows. Around 75% of PLHIV had monthly incomes of less than 50,000F CFA (81.16 USD). Prevalence of HIV serodiscordance was 71.70%. It was 70.91% [65.54% - 76.28%] at care sites and 73.24% [65.95% - 80.52%] at sites involved in preventing mother-to-child transmission (PMTCT sites). Potential predictors of HIV serodiscordance were: household head status;serostatus of last child;duration of relationship;multiple and occasional sexual partners;sharing serostatus with spouse;duration of couple relationship;spouse’s extramarital relationships and strained relations with children. Conclusion: Response strategies against the HIV pandemic need to be reshaped to better supervise the follow-up of HIV serodiscordant couples in the city of Parakou specifically and in Benin in general.

Improving Post Abortion Care (PAC) Delivery in Sub-Saharan Africa: A Literature Review

Saharan Africa (SSA) contributes 29% of the global unsafe abortions with 62% of abortion-related deaths. This is due to restrictive abortion laws, low quality post abortion care (PAC) and inadequate access to effective modern contraception. The overall objective was to review current literature on PAC in SSA and make recommendations for improvement especially in Cameroon. A literature review was conducted on PAC in SSA published during 2000-2018. The following databases were searched: MEDLINE, POPLINE, COCHRANE Library, African Index Medicus and GOOGLE Scholar. Thirty articles were reviewed from 16 countries ranging from observational studies to systematic reviews with meta-analysis. Major outcomes: 1) Manual vacuum aspiration (MVA) and misoprostol are equally safe and effective. 2) There is comparable effectiveness between physicians and trained mid-level cadres in PAC management. 3) PAC contraception uptake was increased when offered immediately before patient leaves the facility. 4) Gaps to PAC service use include inadequate access, low quality care and less adolescent-friendly environment. Task shifting of PAC to trained mid-level staff, decentralization of medical PAC using misoprostol, offering post abortion counselling and contraception to clients before leaving the health facility, encouraging linkage and provider-community partnership in PAC and reinforcement of advocacy for less restrictive abortion laws in Cameroon are recommended.